Hillary Snapp

A clinical protocol for predicting outcomes with an implantable prosthetic device (Baha) in patients with single-sided deafness.

BACKGROUND The Baha implant is increasingly becoming a common form of treatment for individuals with single-sided deafness (SSD). However, evidence-based guidelines for determining candidacy in these patients are not yet established. PURPOSE The purpose of this study was to investigate the clinical utility of speech-in-noise testing as a part of the preoperative evaluation of the Baha device in patients with SSD. RESEARCH DESIGN The study design was a prospective cohort of 24 English-speaking adults comparing preoperative results on speech-in-noise measures using the Baha Cordelle II headband stimulator to postoperative results using the patients external Baha processor. INTERVENTION Outcome measures included signal-to-noise ratio (SNR) loss as measured by the QuickSIN™ and scores of self-reported disability questionnaires. RESULTS Wilcoxon signed-rank test resulted in no significant difference between the preoperative and postoperative methods for measuring benefit on listening in noise tasks. Passing Bablok regression analysis showed the preoperative and postoperative results to be statistically equivalent, which suggests that postoperative results can be predicted during preoperative testing. Wilcoxon signed-rank test showed significant improvements in self-reported disability postoperatively. CONCLUSIONS The results support the use of speech-in-noise measures as an accurate predictor of overall benefit in patients with SSD prior to implantation.

Postoperative validation of bone-anchored implants in the single-sided deafness population.

Objective The purpose of this study was to present objective and subjective outcomes on speech-in-noise testing as a predictor of patient performance after bone-anchored implant surgery in patients with single-sided deafness (SSD). Design Retrospective review of adult subjects who received bone-anchored implants for the indication of SSD comparing results on speech-in-noise measures in the unaided condition to postoperative aided condition using the patient’s external bone-anchored implant processor as a validation of device performance. Setting Tertiary referral center providing outpatient surgical and audiologic care. Patients Adult English speaking subjects with SSD who underwent bone-anchored implantation between 2005 and 2010. Intervention Subjects were evaluated with speech-in-noise measures in the sound field using a 90/270 speaker configuration in both the unaided and aided implant condition for validation of implant performance. Subjective benefit was evaluated using the Glasgow Hearing Aid Benefit Profile. Main Outcome Measures Outcome measures included signal-to-noise ratio (SNR) loss and word recognition ability in noise as measured using the QuickSIN and the Glasgow Hearing Aid Benefit Profile. Results A significant improvement in speech-in-noise measures was noted in the postoperative aided condition when compared with the unaided condition (Wilcoxon signed-rank test, p < 0.0001). Significant decrease in disability postoperatively also was observed (Wilcoxon signed-rank test, p < 0.001). Positive associations were observed for postoperative aided SNR loss and benefit, satisfaction, and use. Passing-Bablok regression analysis showed the preoperative and postoperative results to be statistically equivalent. Conclusion The results support the use of speech-in-noise measures as an accurate postimplantation assessment of overall benefit in patients with SSD. SNR loss is a good predictor of postoperative subjective benefit and satisfaction.

Oculomotor, Vestibular, and Reaction Time Tests in Mild Traumatic Brain Injury.

Objective Mild traumatic brain injury is a major public health issue and is a particular concern in sports. One of the most difficult issues with respect to mild traumatic brain injury involves the diagnosis of the disorder. Typically, diagnosis is made by a constellation of physical exam findings. However, in order to best manage mild traumatic brain injury, it is critically important to develop objective tests that substantiate the diagnosis. With objective tests the disorder can be better characterized, more accurately diagnosed, and studied more effectively. In addition, prevention and treatments can be applied where necessary. Methods Two cohorts each of fifty subjects with mild traumatic brain injury and one hundred controls were evaluated with a battery of oculomotor, vestibular and reaction time related tests applied to a population of individuals with mild traumatic brain injury as compared to controls. Results We demonstrated pattern differences between the two groups and showed how three of these tests yield an 89% sensitivity and 95% specificity for confirming a current diagnosis of mild traumatic brain injury. Interpretation These results help better characterize the oculomotor, vestibular, and reaction time differences between those the mild traumatic brain injury and non-affected individuals. This characterization will allow for the development of more effective point of care neurologic diagnostic techniques and allow for more targeted treatment which may allow for quicker return to normal activity.

Ethnic disparity in skin complications following bone-anchored hearing aid implantation.

Objectives Sound processor loading after implantation of a bone-anchored hearing aid is often delayed by skin-site complications. This study examined the frequency of skin-site complications in various ethnic groups and determined factors that may lead to higher rates of skin-site complications resulting in delayed processor loading. Methods Adult, English-speaking patients who underwent implantation of a bone-anchored hearing aid between 2007 and 2010 were reviewed. Demographic data including ethnicity, tobacco use, diabetes mellitus, immunosuppression, and long-term steroid use were determined. Major and minor skin-site complications and the time to processor loading were recorded. Results The mean time to processor loading was 9.5 weeks, and the mean follow-up time was 23 months. There were no cases of osseointegration failure. African American patients had a significantly higher rate of major skin-site complications (p < 0.005) and a longer time to processor loading (mean, 17.6 weeks; p < 0.05) than the other ethnic groups. There was no significant difference in minor skin complication rates. There was no correlation between diabetes mellitus, long-term immunosuppression, or tobacco use and skin-site complications. Conclusions Skin complications can delay processor loading following implantation of a bone-anchored hearing aid. There is a higher rate of major skin-site complications in African American patients, and these often delay processor loading. The risk of skin-site complications is not correlated with smoking, diabetes mellitus, or immunosuppression. An increased risk of skin-site complications is an important consideration for preoperative counseling.

Bone-anchored implantation for single-sided deafness in patients with less than profound hearing loss.

Objective The benefit of bone-anchored implantation (BAI) for the treatment of single-sided deafness (SSD) is well established. In this study, the authors sought to evaluate objective hearing outcomes and subjective benefits in patients undergoing BAI for SSD with residual hearing in the implanted ear. Study Design Case series with chart review. Setting Academic tertiary referral center. Subjects and Methods All adult, English-speaking patients undergoing BAI for SSD from 2004 to 2010 were included. Patients were divided into 2 groups: (1) residual hearing in the affected ear (≤90 db hearing level [HL] pure-tone average [PTA]) and (2) profound hearing loss in the affected ear (>90 dB HL PTA). Patients underwent pre- and postoperative objective hearing outcomes testing including speech-in-noise and monosyllabic word tests. Subjective outcomes were measured pre- and postoperatively using the Glasgow Hearing Aid Benefit Profile (GHABP). Results Patients in both groups showed significant improvement in all objective hearing measures following implantation (P < .0001), and there were no significant differences in objective hearing outcomes between groups. Subjective benefits from BAI varied across patients according to GHABP results, but patients with residual hearing in the affected ear trended toward improved satisfaction with their device postoperatively. Conclusion Individuals with SSD and residual cochlear reserve can be successfully implanted with BAI, achieving significant improvements in objective hearing measures. Postoperative improvements do not seem to correlate with the preoperative audiometric testing scores. Although subjective benefit varies across patients, BAI is clearly a viable rehabilitation option for patients with SSD and less than profound hearing loss.

Early Loading After Single-Stage Bone-Anchored Implantation in Adults

Objective. Classically, processor loading after single-stage bone-anchored implantation (BAI) surgery follows a 3-month osseointegration period. The purpose of this study was to examine audiometric outcomes and postoperative complications in adult patients undergoing single-stage BAI with processor loading at less than 6 weeks postoperatively. Study Design. Retrospective review. Setting. Otology clinic in a tertiary care academic center. Subjects and Methods. A retrospective review was performed of all adult patients (>18 years) undergoing BAI from 2007 to 2010. Sixty-four patients met inclusion criteria. Fifty-five patients had unilateral hearing loss, including single-sided deafness, conductive hearing loss, or mixed hearing loss. Nine patients had bilateral hearing loss. Patients were divided into groups based on time to processor loading (>12 weeks, <12 weeks, <6 weeks). All patients were loaded with the external processor at less than 6 weeks when possible. Preoperative and postoperative audiometric evaluations were performed. Results. There were no cases of osseointegration failure. All groups showed significant improvement in audiometric testing using their BAI (P < .005), and there were no significant differences between patients loaded at less than 12 weeks and those loaded at less than 6 weeks (P > .05). Major skin complications were seen in 9% of subjects and minor complications in 30%. Conclusions. Single-stage BAI implantation with early processor loading is safe and effective in adults. All groups demonstrated significant audiometric benefit that was not affected in patients loaded early. Major and minor skin-site complications frequently delayed processor loading, but there were no cases of osseointegration failure in any group.

The use of oculomotor, vestibular, and reaction time tests to assess mild traumatic brain injury (mTBI) over time: OVRT Test to Assess mTBI

The objective of this work is to examine the outcomes of a set of objective measures for evaluating individuals with minor traumatic brain injury (mTBI) over the sub‐acute time period. These methods involve tests of oculomotor, vestibular, and reaction time functions. This work expands upon published work examining these test results at the time of presentation.

Utricular Dysfunction in Refractory Benign Paroxysmal Positional Vertigo.

Objective To determine the prevalence of otolith dysfunction in patients with refractory benign paroxysmal positional vertigo (BPPV). Study Design Unmatched case control. Setting Tertiary care institution. Subjects and Methods Patients included were diagnosed with BPPV, failed initial in-office canalith repositioning maneuvers (CRMs), and completed vestibular testing and vestibular rehabilitation (n = 40). Refractory BPPV (n = 19) was defined in patients whose symptoms did not resolve despite vestibular rehabilitation. These patients were compared with a control group of those with nonrefractory BPPV (n = 21) for results of a caloric test, cervical vestibular evoked myogenic potential (cVEMP), and subjective visual vertical (SVV). Results Forty-six of 251 patients failed initial treatment with in-office CRM. Forty patients met inclusion criteria. There was no significant difference between the cases (refractory BPPV) (n = 19) and controls (nonrefractory BPPV) (n = 21) in terms of age, duration of symptoms, laterality of BPPV, and BPPV symptoms. There was no difference in the prevalence of caloric weakness and cVEMP abnormalities (P > .05), with odds ratios (ORs [95% confidence interval (CI)]) of having abnormal results among cases vs controls of 1.1818 (0.3329-4.1954) and 4.3846 (0.7627-25.2048), for caloric and cVEMP, respectively. Abnormal eccentric SVV was more prevalent in refractory BPPV cases (58%) than in controls (14%) (P < .0072). The OR (95% CI) of having abnormal SVV was 8.25 (1.7967-37.8822) higher among patients with refractory BPPV than those with nonrefractory BPPV. Conclusion Patients with refractory BPPV are more likely to have abnormal eccentric SVV and thus underlying utricular dysfunction. This finding is important to take into account when designing rehabilitation strategies for patients with BPPV who fail CRM.

Comparison of Speech-in-Noise and Localization Benefits in Unilateral Hearing Loss Subjects Using Contralateral Routing of Signal Hearing Aids or Bone-Anchored Implants.

OBJECTIVE To compare the benefit of wireless contralateral routing of signal (CROS) technology to bone-anchored implant (BAI) technology in monaural listeners. STUDY DESIGN Prospective, single-subject. SETTING Tertiary academic referral center. PATIENTS Adult English speaking subjects using either a CROS hearing aid or BAI as treatment for unilateral severe-profound hearing loss. INTERVENTIONS Aided performance utilizing the subjects BAI or CROS hearing device. MAIN OUTCOME MEASURES Outcome measures included speech-in-noise perception using the QuickSIN (Etymotic Research, Elkgrove Village, IL, 2001) speech-in-noise test and localization ability using narrow and broadband stimuli. Performance was measured in the unaided and aided condition and compared with normal hearing controls. Subjective outcomes measures included the Speech Spatial and Qualities hearing scale and the Glasgow Hearing Aid Benefit Profile. RESULTS A significant improvement in speech-in-noise performance for monaural listeners (p < 0.0001) was observed, but there was no improvement in localization ability of either CROS or BAI users. There was no significant difference between CROS and BAI subject groups for either outcome measure. BAI recipients demonstrate higher initial disability and handicap over CROS hearing aid users. No significant difference was observed between treatment groups for subjective measures of post-treatment residual disability or satisfaction. CONCLUSIONS Our data demonstrate that both CROS and BAI systems provide significant benefit for monaural listeners. There is no significant difference between CROS or BAI systems for objective measures of speech-in-noise performance. CROS and BAI hearing devices do not provide any localization benefit in the horizontal plane for monaural listeners and there is no significant difference between systems.

Transcranial Attenuation in Patients with Single-Sided Deafness.

Transcranial attenuation (TA) of bone-conducted sound has a high degree of variability by frequency and subject, which may play a role in the objective benefit of individuals with single-sided deafness (SSD) treated with a bone-anchored implant (BAI). This study sought to determine whether TA is predictive of benefit in individuals with SSD who receive a BAI. Adult, English-speaking patients with unilateral profound sensorineural hearing loss who underwent a BAI evaluation were included for study. Absolute TA values were consistent with previously published reports. Regression analysis indicated no correlation between TA values and aided speech-in-noise performance for any combined or individual frequencies. Measures of TA do not provide predictive value in determining behavioral outcomes in the SSD population. Specifically, low TA does not suggest improved outcomes with a BAI.